Febuxostat – a tablet for gout prevention and other uric acid-related conditions

Generic name: Febuxostat [ fe-BUX-oh-stat]
Brand name: Adenuric (UK)/Uloric (US)
What it is: Xanthine oxidase inhibitor
Who benefits from it: People with long-term gout and other conditions caused by high levels of uric acid
Tablet form: 40 mg; 80 mg

What is febuxostat?

Febuxostat is a medication prescribed for the long-term management and prevention of gout.

It is typically introduced if the standard first-line medication, allopurinol, is not suitable, causes severe side effects, or has not worked well enough.

Uses (who benefits from it)

Febuxostat is used for people with:

• Chronic hyperuricaemia (persistently high blood uric acid levels) where urate crystals have already deposited in the body

• Recurrent or troublesome gout flares

• Tophi (gouty lumps that form under the skin or around joints)

• Chronic gouty arthritis or joint damage caused by gout attacks

• A history of allopurinol intolerance, or where allopurinol treatment is not advisable

Dosage

Febuxostat is taken as a single tablet once daily, with or without food, at the same time each day:

• Starting Dose: Typically 80 mg once daily.

• Dose Increase: If blood tests after 2 to 4 weeks show that uric acid levels are still too high, the dose may be increased to 120 mg once daily.

• Specialist Initiation: Treatment is usually started at least 2 weeks after an acute gout flare has completely settled.

Note: Patients must not stop taking febuxostat without medical advice, even if they experience a sudden gout flare. It can take up to 6 months to become fully effective, and stopping it suddenly can cause uric acid levels to surge.

Side-effects

The most common paradox of starting febuxostat is a short-term increase in gout flares during the first few months of treatment.

This happens as shifting blood urate levels cause old crystal deposits to mobilise and dissolve. Doctors often prescribe a temporary anti-inflammatory or colchicine alongside it to prevent this issue.

Other general side effects include:

• Headaches

• Feeling sick (nausea) or diarrhoea

• Skin rashes

• Altered liver function test results

• Fluid retention and mild swelling, usually in the lower legs and ankles

Serious allergic reactions or severe skin rashes are rare but require immediate medical attention.

Febuxostat is also generally avoided in patients with a history of major cardiovascular disease, such as a previous heart attack or stroke.

How it works

When your body has too much uric acid, the excess can form tiny, sharp, grit-like crystals in and around your joints and tendons. These crystals irritate the surrounding tissue, causing the intense swelling, redness, and severe pain characteristic of a gout flare.

Febuxostat works by blocking xanthine oxidase, the specific enzyme responsible for generating uric acid. By reducing total production, febuxostat brings blood urate levels down into a target range, allowing existing crystals to gradually dissolve and stopping new ones from forming.

Monitoring

Your doctor should monitor:

• Serum urate (uric acid) levels to confirm the medication is successfully maintaining your target level (typically below 360 µmol/L or 300 µmol/L)

• Liver function tests (LFTs) via blood checks prior to starting treatment and periodically thereafter

• Cardiovascular health and blood pressure

• Concomitant medications, as febuxostat must not be taken alongside specific drugs like azathioprine or mercaptopurine due to a risk of serious bone marrow suppression

Other resources

• NHS: Febuxostat to Prevent Gout Attacks – Medicines Guide

• BNF: Febuxostat Monograph – British National Formulary

• NICE: Gout: Diagnosis and Management [NG219] – Clinical Guideline

• Mayo Clinic (USA): Febuxostat (Oral Route) Patient Information